MEDICARE: HEATHER HAINSTOCK PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	103TC0700X	Clinical Psychologist	203183	ID

General Provider Information

NPI Number	:	1194105395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER HAINSTOCK PSY.D.

Provider Business Mailing Address
First Line	:	3340 E GOLDSTONE DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-1026
Country	:	US
Telephone Number	:	208-367-5170
Fax Number	:

Provider Business Practice Location Address
First Line	:	1859 S TOPAZ WAY STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-4401
Country	:	US
Telephone Number	:	208-209-2432
Fax Number	:	847-859-5885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	06/09/2021

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Directions to “ HEATHER HAINSTOCK PSY.D.” Practice Location

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